Counselling Appointment Request Form

Start the conversation

By filling out the Counselling Appointment Request Form below, you are taking the first step towards the change you want to see in your life. There is no obligation to start counselling once you’ve submitted this form. We will have the chance to talk before setting up your first appointment. Once your form is received, we will contact you within 48 hours to discuss your counselling needs further. You may also choose to contact us by telephone at 613-825-2681.

Name(required)

Email(required)

Phone

How do you prefer to be reached? E-mail

Phone

Type of counselling you are interested in?

Please tell us a bit about what you are seeking counselling for. Feel free to ask any questions here as well.